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Regional myocardial dysfunction following Norwood with right ventricle to pulmonary artery conduit in patients with hypoplastic left heart syndrome.
J Am Soc Echocardiogr. 2011 Aug; 24(8):826-33.JA

Abstract

BACKGROUND

Improved early survival has led many centers to use the right ventricle-to-pulmonary artery (RVPA) conduit instead of the modified Blalock-Taussig shunt for Norwood palliation of hypoplastic left-heart syndrome. However, there is concern regarding the potential deleterious effects of the required right ventriculotomy for placement of the RVPA conduit on global and regional right ventricular (RV) function. The purpose of this study was to investigate global and regional RV wall motion abnormalities after Norwood palliation with RVPA conduit using Velocity Vector Imaging (VVI).

METHODS

Thirty consecutive patients with hypoplastic left-heart syndrome who underwent stage 2 palliation between January 2007 and December 2009 were identified from the surgical database. VVI was performed on two-dimensional echocardiographic images obtained before second-stage palliation. Peak systolic circumferential and radial velocity, strain, and strain rate were measured from parasternal short-axis and apical four-chamber views. RV ejection fraction was measured using the biplane modified Simpson's rule. Regional RV systolic deformations were compared between different RV segments. VVI measures were also compared with RV systolic function. In a subgroup (n = 14), VVI was repeated on follow-up after stage 2 palliation to evaluate changes in regional and global RV deformation.

RESULTS

A total of 30 patients (20 males) were studied. The median age at the time of interstage echocardiography was 12 weeks (range, 8-18 weeks). In the short axis, average peak systolic circumferential strain values for the anterior, posterior, septal, and RV free wall segments were 3.79 ± 2.52%, 11.4 ± 5.2%, 13.3 ± 6.5%, and 11.1 ± 5.0%, respectively. From the short-axis view, the anterior RV segment (ventriculotomy site) exhibited significantly reduced circumferential velocity, peak systolic strain, and strain rate (P < .0001). Mean global VVI measurements were correlated with RV ejection fraction. On follow-up after stage 2 palliation, the ventriculotomy region showed persistently reduced velocity, peak systolic strain, and strain rate compared with all other segments.

CONCLUSIONS

In patients with hypoplastic left-heart syndrome after Norwood palliation with RVPA conduit, RV myocardial deformation was significantly reduced at the ventriculotomy site, which persisted after stage 2 palliation. VVI-derived measures demonstrating impairment of global systolic myocardial deformation were correlated with RV systolic function. Long-term multicenter studies to evaluate the effects of ventriculotomy scar on single systemic right ventricle are required.

Authors+Show Affiliations

Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah 84113, USA. shaji.menon@utah.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21680148

Citation

Menon, Shaji C., et al. "Regional Myocardial Dysfunction Following Norwood With Right Ventricle to Pulmonary Artery Conduit in Patients With Hypoplastic Left Heart Syndrome." Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography, vol. 24, no. 8, 2011, pp. 826-33.
Menon SC, Minich LL, Casper TC, et al. Regional myocardial dysfunction following Norwood with right ventricle to pulmonary artery conduit in patients with hypoplastic left heart syndrome. J Am Soc Echocardiogr. 2011;24(8):826-33.
Menon, S. C., Minich, L. L., Casper, T. C., Puchalski, M. D., Hawkins, J. A., & Tani, L. Y. (2011). Regional myocardial dysfunction following Norwood with right ventricle to pulmonary artery conduit in patients with hypoplastic left heart syndrome. Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography, 24(8), 826-33. https://doi.org/10.1016/j.echo.2011.05.008
Menon SC, et al. Regional Myocardial Dysfunction Following Norwood With Right Ventricle to Pulmonary Artery Conduit in Patients With Hypoplastic Left Heart Syndrome. J Am Soc Echocardiogr. 2011;24(8):826-33. PubMed PMID: 21680148.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Regional myocardial dysfunction following Norwood with right ventricle to pulmonary artery conduit in patients with hypoplastic left heart syndrome. AU - Menon,Shaji C, AU - Minich,L Luann, AU - Casper,T Charles, AU - Puchalski,Michael D, AU - Hawkins,John A, AU - Tani,Lloyd Y, Y1 - 2011/06/15/ PY - 2010/12/03/received PY - 2011/6/18/entrez PY - 2011/6/18/pubmed PY - 2011/12/24/medline SP - 826 EP - 33 JF - Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography JO - J Am Soc Echocardiogr VL - 24 IS - 8 N2 - BACKGROUND: Improved early survival has led many centers to use the right ventricle-to-pulmonary artery (RVPA) conduit instead of the modified Blalock-Taussig shunt for Norwood palliation of hypoplastic left-heart syndrome. However, there is concern regarding the potential deleterious effects of the required right ventriculotomy for placement of the RVPA conduit on global and regional right ventricular (RV) function. The purpose of this study was to investigate global and regional RV wall motion abnormalities after Norwood palliation with RVPA conduit using Velocity Vector Imaging (VVI). METHODS: Thirty consecutive patients with hypoplastic left-heart syndrome who underwent stage 2 palliation between January 2007 and December 2009 were identified from the surgical database. VVI was performed on two-dimensional echocardiographic images obtained before second-stage palliation. Peak systolic circumferential and radial velocity, strain, and strain rate were measured from parasternal short-axis and apical four-chamber views. RV ejection fraction was measured using the biplane modified Simpson's rule. Regional RV systolic deformations were compared between different RV segments. VVI measures were also compared with RV systolic function. In a subgroup (n = 14), VVI was repeated on follow-up after stage 2 palliation to evaluate changes in regional and global RV deformation. RESULTS: A total of 30 patients (20 males) were studied. The median age at the time of interstage echocardiography was 12 weeks (range, 8-18 weeks). In the short axis, average peak systolic circumferential strain values for the anterior, posterior, septal, and RV free wall segments were 3.79 ± 2.52%, 11.4 ± 5.2%, 13.3 ± 6.5%, and 11.1 ± 5.0%, respectively. From the short-axis view, the anterior RV segment (ventriculotomy site) exhibited significantly reduced circumferential velocity, peak systolic strain, and strain rate (P < .0001). Mean global VVI measurements were correlated with RV ejection fraction. On follow-up after stage 2 palliation, the ventriculotomy region showed persistently reduced velocity, peak systolic strain, and strain rate compared with all other segments. CONCLUSIONS: In patients with hypoplastic left-heart syndrome after Norwood palliation with RVPA conduit, RV myocardial deformation was significantly reduced at the ventriculotomy site, which persisted after stage 2 palliation. VVI-derived measures demonstrating impairment of global systolic myocardial deformation were correlated with RV systolic function. Long-term multicenter studies to evaluate the effects of ventriculotomy scar on single systemic right ventricle are required. SN - 1097-6795 UR - https://www.unboundmedicine.com/medline/citation/21680148/Regional_myocardial_dysfunction_following_Norwood_with_right_ventricle_to_pulmonary_artery_conduit_in_patients_with_hypoplastic_left_heart_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0894-7317(11)00360-9 DB - PRIME DP - Unbound Medicine ER -